By using this form, you agree:

1) To use an electronic document and an electronic signature and understand that electronic signatures are legally binding.

2) To read the document and fill it out accurately and completely.

3) To receive, after signing and submitting the form, a system-generated email containing the completed, signed document.

The purpose of this agreement is to document that Institute for International Medicine ("INMED") and the company providing financial support ("Ineligible Company") will observe the guidelines and regulations related to commercial support for CME activities issued by the Kentucky Medical Association and the Accreditation Council for Continuing Education. This agreement is not a contract for services rendered, but simply documents both party's affirmation that appropriate procedures and policies will govern the use of support.

Independence

1. This activity is for educational purposes only and will not promote any specific proprietary business interest of an ACCME defined Ineligbile Company.
2. INMED (accredited provider) is responsible for all decisions regarding the identification of educational needs, determination of educational objectives, selection and presentation of content, selection of all persons or entities that will be in a position to control the content of this activity, selection of education methods, and the evaluation of the activity.

Appropriate Use of Commercial Support

1. INMED (accredited provider) will make all decisions regarding the disposition and disbursement of support from Ineligible Company.
2. Ineligible Company will not require INMED to accept advice or services concerning teachers, authors, participants, or other education matters, including content, as conditions of receiving support.
3. All commercial support associated with this activity will be given with the full knowledge and approval of INMED. No other payments shall be given to the director of the activity, planning commitee members, teachers or authors, educational partners, or any others involved with this activity.
4. INMED will, upon request, furnish Ineligible Company documentation detailing the receipt and expenditure of the commercial support.
5. The names or contact information of learners will not be shared with Ineligible Company or its agents without the explicit consent of the individual learner.
    

Commercial Promotion

1. Product-promotion material or product specific advertisement of any type is prohibited in or during the activity. Ineligible Company promotional activities must be kept separate from CME activity. Promotional materials are not allowed to be displayed or distributed in the educational space within 30 minutes before or after an accredited education activity. Ineligible Company may not engage in sales promotional activities while in the space or place of an activity.
2. Ineligible Company may not be the agent providing the educational activity to the learners.

Disclosure

1. In the case of grants, INMED will ensure that the source of support from the Ineligible Company, either direct or "in-kind," is disclosed to the participants through INMED approved media prior to and at the time of the activity.  The disclosure will not include the use of a corporate logo, trade name, or product-group message of an Ineligible Company.